了解存在阿片类药物高风险使用的初级保健患者的特征及共病情况：来自多中心“阈下阿片类药物使用障碍预防”（STOP）试验的基线数据
Understanding the characteristics and comorbidities of primary care patients with risky opioid use: Baseline data from the multi-site "Subthreshold Opioid Use Disorder Prevention" (STOP) Trial.
作者信息
Rostam-Abadi Yasna, Liebschutz Jane M, Subramaniam Geetha, Stone Rebecca, Appleton Noa, Mazel Shayna, Alexander Karen, Brill Seuli Bose, Case Ashley, Gelberg Lillian, Gordon Adam J, Hong Hyunouk, Incze Michael A, Kawasaki Sarah S, Kim Tobie, Kline Margaret, Lovejoy Travis I, McCormack Jennifer, Zhang Song, McNeely Jennifer
机构信息
Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA.
Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, UPMC, Pittsburgh, PA, 15213, USA.
出版信息
J Gen Intern Med. 2025 Jun 2. doi: 10.1007/s11606-025-09613-4.
BACKGROUND
A majority of the 8.9 million Americans with opioid misuse have mild or no symptoms of opioid use disorder (OUD), but they may be at elevated risk of developing more severe OUD, overdose, or other health consequences of opioid use. The "Subthreshold Opioid Use Disorder Prevention"(STOP) Trial is evaluating a collaborative care intervention for risky opioid use in primary care. Here, we describe baseline characteristics of participants to understand their needs and assess the generalizability of the sample.
METHODS
Recruitment at five primary care sites spanned March 2021-May 2023. Adult patients who screened positive for subthreshold OUD (current illicit or non-medical opioid use without meeting DSM-5 criteria for moderate-severe OUD) were eligible. Baseline assessments measured self-reported demographic characteristics, other substance use, pain, and physical and mental health symptoms. Descriptive statistics summarize characteristics of the enrolled sample across sites.
RESULTS
Among the 202 participants, the majority identified as female (63.4%), white (70.8%), and non-Hispanic (96.5%), with mean age 55.7 (SD: 12.7) years. Nearly half (49.0%) had problem or high-risk use of prescription opioids, and most received a prescription for opioid medication in the past six months (74.8%). Many participants reported current problem use or high-risk use of alcohol (47.0%) or cannabis (31.2%). Approximately one-third endorsed mental health symptoms, including moderate-severe anxiety (35.6%), depression (31.2%), or sleep disturbance (29.7%), and 20.3% reported a past suicide attempt. In the prior six months, 14.7% had experienced a nonfatal overdose. Moderate-severe pain was reported by 63.4%, and 60.4% rated their general health as fair or poor.
CONCLUSIONS
Patients with subthreshold OUD had high rates of polysubstance use and comorbidities that may present challenges to reducing risky opioid use. The STOP trial presents an opportunity to detect and address subthreshold OUD in a cohort with considerable medical and social needs, within primary care settings.
CLINICAL TRIALS REGISTRATION
ClinicalTrials.gov NCT04218201.
背景
在890万滥用阿片类药物的美国人中，大多数人有轻度阿片类药物使用障碍（OUD）症状或无症状，但他们患更严重OUD、过量用药或阿片类药物使用导致的其他健康后果的风险可能更高。“阈下阿片类药物使用障碍预防”（STOP）试验正在评估针对初级保健中危险阿片类药物使用的协作护理干预措施。在此，我们描述参与者的基线特征，以了解他们的需求并评估样本的普遍性。
方法
2021年3月至2023年5月在五个初级保健地点进行招募。筛查出阈下OUD呈阳性的成年患者（目前非法或非医疗使用阿片类药物但未达到DSM-5中重度OUD标准）符合条件。基线评估测量了自我报告的人口统计学特征、其他物质使用情况、疼痛以及身心健康症状。描述性统计总结了各地点入组样本的特征。
结果
在202名参与者中，大多数为女性（63.4%）、白人（70.8%）、非西班牙裔（96.5%），平均年龄55.7岁（标准差：12.7）。近一半（49.0%）的人存在处方阿片类药物问题使用或高风险使用情况，且大多数人在过去六个月内接受过阿片类药物处方（74.8%）。许多参与者报告目前存在酒精问题使用或高风险使用（47.0%）或大麻问题使用或高风险使用（31.2%）。约三分之一的人认可存在心理健康症状，包括中重度焦虑（35.6%）、抑郁（31.2%）或睡眠障碍（29.7%），20.3%的人报告有过自杀未遂史。在过去六个月内，14.7%的人经历过非致命性过量用药。63.4%的人报告有中重度疼痛，60.4%的人将他们的总体健康状况评为一般或较差。
结论
阈下OUD患者存在多种物质使用和合并症的高发生率，这可能给减少危险阿片类药物使用带来挑战。STOP试验为在初级保健环境中检测和解决有大量医疗和社会需求人群中的阈下OUD提供了一个机会。
临床试验注册
ClinicalTrials.gov NCT04218201。
Zotero 插件